Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 11779R | LA |
NPI | 1235159112 |
---|---|
Provider Name | Kimberly Lynn Jones |
First Address | Shreveport, LA 71118-3153 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 15/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1692255 | (05) | LA |
G60645 | (02) | LA |